Emergency surgery, for the general practitioner.

  • Sluss, John W. (John William), 1867-
Date:
1910
Catalogue details

Licence: Public Domain Mark

Credit: Emergency surgery, for the general practitioner. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    If the wound has actually penetrated to the heart, death is usually bo rapid that no measure <>r relief can be considered. K it is a gunshot wound, death results from shock and hemorrhage; if it is a stab <>r punctured wound, shock plays a very minor part. It is not very likely thai any small size stab wound of the heart interferes at once seriously with the heart's action, unless it involves the coordination renter, which, it is claimed, lies in the upper third of the inter-ven- tricular groove. If the wound in the pericardium be small or valve-like, the blood is retained within the cavity and the constantly increasing intra-peri- cardial pressure effects the softer and more yielding of the structures within the sac—viz., the pulmonary veins and the descending vena cava and the auricles; in this manner, the venous current to the auricles is cut off and the agitated heart works to no purpose. The sense of oppression, the cyanosis, and venous engorgement all bear witness to the compression of the auricles. In the meantime, the pulse grows miserably weak and rapid; the apex beat is lost, the heart sounds are muffled, the pericardial dullness is augmented, and the thoracic wall bulged. In this manner from heart tamponade, death soon ensues. If the wound in the pericardium is large and the pleura opened, the hemorrhage rapidly fills the pleura producing hemo- thorax, scarcely less distressing than the hemo-pericardium. If the opening in the thoracic wall is free, the hemorrhage is external; the blood spurts from the wound or wells up continuously, uncon- trolled by pressure or occlusion, and death ensues from hemorrhage, simply. In spite of all this, however, a wound of the heart is not to be con- sidered as inevitably fatal and beyond surgical skill. The number of reported cases saved by timely intervention is constantly increasing and will increase all the more rapidly as time goes by. Any wound of the heart sufficiently large to produce hemorrhage, whether external or internal, is potentially fatal. The only measure of relief is operation. The pericardium is to be exposed and opened, the heart relieved of pressure, and the wound repaired. The question arises as to how late an operation may be undertaken.